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Canadian Journal of Anesthesia/Journal canadien d'anesthésie
Published in: Canadian Journal of Anesthesia/Journal canadien d'anesthésie 6/2018

01-06-2018 | Continuing Professional Development

Updated guide for the management of malignant hyperthermia

Authors: Sheila Riazi, MSc, MD, Natalia Kraeva, PhD, Philip M. Hopkins, MBBS, MD, FRCA

Published in: Canadian Journal of Anesthesia/Journal canadien d'anesthésie | Issue 6/2018

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Abstract

Purpose

This continuing professional development module aims to prepare anesthesiologists for the timely recognition and management of a malignant hyperthermia (MH) reaction, which is crucial for averting its life-threatening complications and ultimately for the patient’s survival.

Principal findings

Malignant hyperthermia is a genetic disorder of skeletal muscle cells affecting myoplasmic calcium homeostasis. It can present with nonspecific signs of a hypermetabolic reaction, which can be fatal if treatment, including administration of dantrolene sodium, is not implemented promptly. Rapid evaluation and rejection of alternative diagnoses can lead to a prompt diagnosis and treatment and therefore will significantly reduce the complications, including renal failure, cardiac dysfunction, disseminated intravascular coagulation, and death. After the reaction, patients should be observed for a minimum of 24 hr because of the possibility of recrudescence. As it is a genetic condition, survivors and their family members should be referred to a specialized MH centre for further testing and counselling.

Conclusions

The risk of dying from MH has increased over the past few years. A knowledgeable anesthesiologist who is diligent and attentive can recognize signs of an impending MH reaction and treat promptly to avoid complications of this deadly condition.
Literature
1.
Rosenberg H, Pollock N, Schiemann A, Bulger T, Stowell K. Malignant hyperthermia: a review. Orphanet J Rare Dis 2015; 10: 93 ( free access ).
2.
Riazi S, Kraeva N, Hopkins PM. Malignant hyperthermia in the post-genomics era: new perspectives on an old concept. Anesthesiology 2018; 128: 168-80.
3.
Riazi S, Larach MG, Hu C, Wijeysundera D, Massey C, Kraeva N. Malignant hyperthermia in Canada: characteristics of index anesthetics in 129 malignant hyperthermia susceptible probands. Anesth Analg 2014; 118: 381-7.
4.
Larach MG, Gronert GA, Allen GC, Brandom BW, Lehman EB. Clinical presentation, treatment, and complications of malignant hyperthermia in North America from 1987 to 2006. Anesth Analg 2010; 110: 498-507.CrossRefPubMed
5.
Lu Z, Rosenberg H, Li G. Prevalence of malignant hyperthermia diagnosis in hospital discharge records in California, Florida, New York, and Wisconsin. J Clin Anesth 2017; 39: 10-4.CrossRefPubMed
6.
Ording H. Incidence of malignant hyperthermia in Denmark. Anesth Analg 1985; 64: 700-4.PubMed
7.
Rosenberg H, Davis M, James D, Pollock N, Stowell K. Malignant hyperthermia. Orphanet J Rare Dis 2007; 2: 21 (free access).
8.
Monnier N, Krivosic-Horber R, Payen JF, et al. Presence of two different genetic traits in malignant hyperthermia families: Implication for genetic analysis, diagnosis, and incidence of malignant hyperthermia susceptibility. Anesthesiology 2002; 97: 1067-74 (free access).
9.
Gonsalves SG, Ng D, Johnston JJ, et al. Using exome data to identify malignant hyperthermia susceptibility mutations. Anesthesiology 2013; 119: 1043-53 (free access).
10.
Carpenter D, Robinson RL, Quinnell RJ, et al. Genetic variation in RYR1 and malignant hyperthermia phenotypes. Br J Anaesth 2009; 103: 538-48 (free access).
11.
Robinson R, Hopkins P, Carsana A, et al. Several interacting genes influence the malignant hyperthermia phenotype. Hum Genet 2003; 112: 217-8.PubMed
12.
Hopkins PM. Malignant hyperthermia: pharmacology of triggering. Br J Anaesth 2011; 107: 48-56 (free access).
13.
Heytens L, Forget P, Scholtes JL, Veyckemans F. The changing face of malignant hyperthermia: Less fulminant, more insidious. Anaesth Intensive Care 2015; 43: 506-11 (free access).
14.
Rosero EB, Adesanya AO, Timaran CH, Joshi GP. Trends and outcomes of malignant hyperthermia in the United States, 2000 to 2005. Anesthesiology 2009; 110: 89-94 (free access).
15.
Schneiderbanger D, Johannsen S, Roewer N, Schuster F. Management of malignant hyperthermia: diagnosis and treatment. Ther Clin Risk Manag 2014; 10: 355-62 (free access).
16.
Glahn KP, Ellis FR, Halsall PJ, et al . Recognizing and managing a malignant hyperthermia crisis: guidelines from the European Malignant Hyperthermia Group. Br J Anaesth 2010; 105: 417-20 ( free access ).
17.
Larach MG, Localio AR, Allen GC, et al. A clinical grading scale to predict malignant hyperthermia susceptibility. Anesthesiology 1994; 80: 771-9 (free access).
18.
Larach MG, Brandom BW, Allen GC, Gronert GA, Lehman EB. Malignant hyperthermia deaths related to inadequate temperature monitoring, 2007-2012: a report from the North American malignant hyperthermia registry of the Malignant Hyperthermia Association of the United States. Anesth Analg 2014; 119: 1359-66 (free access).
19.
Larach MG. Standardization of the caffeine halothane muscle contracture test. North American Malignant Hyperthermia Group. Anesth Analg 1989; 69: 511-5.CrossRefPubMed
20.
Hopkins PM, Ruffert H, Snoeck MM, et al. European Malignant Hyperthermia Group guidelines for investigation of malignant hyperthermia susceptibility. Br J Anaesth 2015; 115: 531-9 (free access).
21.
Allen GC, Larach MG, Kunselman AR. The sensitivity and specificity of the caffeine-halothane contracture test: a report from the North American Malignant Hyperthermia Registry. The North American Malignant Hyperthermia Registry of MHAUS. Anesthesiology 1998; 88: 579-88 (free access).
22.
Horstick EJ, Linsley JW, Dowling JJ, et al. Stac3 is a component of the excitation-contraction coupling machinery and mutated in Native American myopathy. Nat Commun 2013; 4: 1952 (free access).
23.
Stowell KM. DNA testing for malignant hyperthermia: the reality and the dream. Anesth Analg 2014; 118: 397-406.CrossRefPubMed
24.
Kraeva N, Sapa A, Dowling JJ, Riazi S. Malignant hyperthermia susceptibility in patients with exertional rhabdomyolysis: a retrospective cohort study and updated systematic review. Can J Anesth 2017; 64: 736-43.CrossRefPubMed
25.
Riazi S, Kraeva N, Muldoon SM, et al. Malignant hyperthermia and the clinical significance of type-1 ryanodine receptor gene (RYR1) variants: proceedings of the 2013 MHAUS scientific conference. Can J Anesth 2014; 61: 1040-9 (free access).
26.
Litman RS, Griggs SM, Dowling JJ, Riazi S. Malignant hyperthermia susceptibility and related diseases. Anesthesiology 2018; 128: 159-67.CrossRefPubMed
27.
Bamaga AK, Riazi S, Amburgey K, et al. Neuromuscular conditions associated with malignant hyperthermia in paediatric patients: a 25-year retrospective study. Neuromuscul Disord 2016; 26: 201-6.CrossRefPubMed
28.
O’Flynn RP, Shutack JG, Rosenberg H, Fletcher JE. Masseter muscle rigidity and malignant hyperthermia susceptibility in pediatric patients. An update on management and diagnosis. Anesthesiology 1994; 80: 1228-33 (free access).
29.
Russell T, Riazi S, Kraeva N, Steel AC, Hawryluck LA. Ecstacy-induced delayed rhabdomyolysis and neuroleptic malignant syndrome in a patient with a novel variant in the ryanodine receptor type 1 gene. Anaesthesia 2012; 67: 1021-4 (free access).
30.
Burkman JM, Posner KL, Domino KB. Analysis of the clinical variables associated with recrudescence after malignant hyperthermia reactions. Anesthesiology 2007; 106: 901-6 (free access).
31.
Dobson G, Chong M, Chow L, et al. Guidelines to the practice of anesthesia - revised edition 2017. Can J Anesth 2017; 64: 65-91 (free access).
32.
Barnes C, Stowell KM, Bulger T, Langton E, Pollock N. Safe duration of postoperative monitoring for malignant hyperthermia patients administered non-triggering anaesthesia: an update. Anaesth Intensive Care 2015; 43: 98-104 (free access).
Metadata
Title
Updated guide for the management of malignant hyperthermia
Authors
Sheila Riazi, MSc, MD
Natalia Kraeva, PhD
Philip M. Hopkins, MBBS, MD, FRCA
Publication date
01-06-2018
Publisher
Springer US
Published in
Canadian Journal of Anesthesia/Journal canadien d'anesthésie / Issue 6/2018
Print ISSN: 0832-610X
Electronic ISSN: 1496-8975
DOI
https://doi.org/10.1007/s12630-018-1108-0

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